Duffy: The Hunger Games arrive at the doctor’s office

If the very wealthy are willing to pay as much as $80,000 a year to secure 24/7 access to a physician with multiple Ivy League degrees, how will the rest of us compete in securing access to top flight medical care?

The answer is we won’t.

While Congress struggles with the future of Obamacare and whether Medicaid will be recognizable in the coming year, the question of patient access to competent, seasoned physicians is no less critical. The simple truth is constructing a comprehensive national medical umbrella of any political stripe is academic if the physician pool has been culled by the wealthy. Second and third tier doctors who didn’t make the cut for what is now being called “Private Medical” may well find themselves marginalized and their patients dubious about who is left to diagnosis their illness.

Deliberately avoiding the glare of mass marketing, “Private Medical” has quietly become the Maserati of medical care with a high annual retainer keeping doctors on call. In return, they will appear in the living rooms of the well-heeled client on Christmas Day for a complaint as lowly as an unseemly cough. Without the need to engage in co-payments, insurance caps, or to account for their time, this exclusive gilt-edged approach to patient care removes top flight physicians from today’s relentless health care business model. Liberated from those constrictions, one can understand why top tier doctors might want to be part of “Private Medical.”

The debate is long over as to whether medicine has changed in the country. The business of health care now requires physicians to account for every minute of their work day, asking perfunctory questions of their patients, checking the box and moving on to the next patient sitting in that paper gown perched on the examination table in the next room. If Henry Ford was tasked with inventing assembly line medicine he couldn’t improve on the current condition.

The obvious problem is “Private Medical” effectively creates a caste system for medical care. The uber wealthy will enjoy that exclusive access to the top practitioners. The very wealthy will find a concierge waiting for them at the hospital along with a team of attentive medical experts. The rest of us will consider the walk in “urgent care” clinic. Within a decade the family internist might well disappear altogether, having been burned out by the accountants who actually dictate care. The metrics for patient diagnosis and treatment have already focused on the efficiency of paperwork. But it comes with toxic shock. The opportunities for malpractice will grow because the science of medicine will continue to be reduced to a P & L spreadsheet that many leading doctors want no part of now that “Private Medical” offers alternatives.

The question is will it matter? Is our defacto medical caste system now so embedded that we will accept the brief diagnostic time we have with our physician as dictated by adversarial insurance companies? It is not an idle question because the lethal impact of malpractice looms ever larger.

The exact number of Americans who die each year due to mistakes in our nation’s hospitals vary depending on how you view a survey’s methodology. One report says 98,000 people die annually. A 2010 report from the Office of Inspector General for Health and Human Services suggests 180,000 patients who are in Medicare. And yet one report believes there are as many as 440,000 deaths annually from the poor care delivered in hospitals.

If you agree to accept the middle number of 180,000, then malpractice becomes the third leading cause of death in America, right behind heart disease and cancer.

The free market will invariably dictate who has access to what doctor, at what cost and with what probable outcome. But perhaps we are debating the wrong issue in Washington. Insurance is crucial but so too is a patient’s Bill of Rights that creates stronger protections against malpractice with far tougher oversight of a health care industry that fails to protect the “Common Joe,” those patients who find themselves the odd man out in a physician’s version of the Hunger Games.

Duffy, managing partner of the law firm Duffy & Duffy of Uniondale, N.Y. is an experienced civil litigator who concentrates his practice on catastrophically injured victims and wrongful death claims involving medical malpractice and personal injury.

One comment

Mr. Duffy, you make some excellent points. As a concierge physician who has left the insurance based practice model after working diligently for decades to shift it’s progression unsuccessfully, I believe I am qualified to comment.

There are many reasons why a physician might enter “Private Medical”, not just the obvious lifestyle consideration. For example, the data is rich with evidence to support the notion that the “happy” doctor provides better care. That doctor rarely, if ever, exists today in the hamster wheel that is insurance based medicine. Being unable to provide a wholistic patient focused approach in the 6 minutes or so available to each individual face to face encounter drives a good bit of the issues around medical errors. Realize, too, that the percentage of “Private Medical” doctors at present is a tiny fraction – medical errors do not exist because the best have been culled – they exist because the majority don’t have time or energy to avoid them.

The system functions precisely as it was designed. Unfortunately, from a patient and doctor perspective, there is no question that the system is broken. Any physician within an insurance structure is continually burdened with more and more administrative headaches – prior authorizations from insurance companies, coding reviews for overpayment, quality chart checkups, as well as increasing requirements to demonstrate that “you’ve done a good job” or you get your fees cut even further. These mandates come from misguided attempts to “ensure quality”, and frequently cut significantly into the time practices have to focus on patients – if you hire someone to do paperwork, you have to pay them with more patient visits, and not usually by adding providers. Standards of living go down, aggravation goes up and the patient again gets the short end of the stick.

If “Private Medicine” can provide some patients a level of care that is otherwise unavailable, they win. The doctor wins because they are not losing their minds and their livelihoods. My hope is that the population, as well as the powers, come to recognize that the system is in desperate need of repair and that “Private Medicine” will become the standard by which all care is delivered.

Fundamentally what needs to happen is that everyone needs to wake up to the fact that the doctor is not responsible for your health – you are. That means actually taking care of yourself, and if that is enhanced by individuals having more responsibility (read “high deductible health plan”), then everyone wins. But we are a long way from the majority of the population doing that, and the market forces continue to work against that at every turn.

But as President Trump said “Nobody knew health care could be so complicated”.